MDGuidelines API: Case Fit v3 Specification 1.3

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1 MDGuidelines API: Case Fit v3 Specification 1.3 Date: August 23, 2017

2 1 Overview 1.1 Purpose and Intended Audience The purpose of this document is to provide detailed descriptions and specifications for the Case Fit API The Case Fit API is intended to be used by MDGuidelines customers and partners that have integrated MDGuidelines into their own products and wish to display predicted Case Durations within their application(s). The Case Fit API is part of the MDGuidelines API product offering for Integration Customers. The version number of this document refers to the Specification version. See Section 2.3 Version Information below for information related to the API version. 1.2 Description The Case Fit end point accomplishes two pre-processing steps for using the predictive model in the Case API: 1. The Case Fit can be used to identify whether a Case Prediction is available for the given Primary Diagnosis, prior to having the integrated system end user fill out the other details for the case (such as age, sex, or program type). 2. The Case Fit also indicates which Comorbid Groups are relevant and significant to the requested Primary Diagnosis. The Case Fit API requires a billable ICD-9-CM or ICD-10-CM medical diagnosis code. When a predicted duration is available, the response will provide all of the Comorbid Group data and an indicator for whether the given Comorbid Group code is significant for the supplied Primary Diagnosis. The Comorbid Group data describes the relationship of other comorbidities to the Primary Diagnosis. If a particular comorbid condition is a member of a Comorbid Group, the Case duration calculation will require the use of the Comorbid Group code rather than the specific comorbidity medical code. More information about the calculation can be found in the Case API v3 specification. To obtain the Comorbid Group Code that a given comorbiditity belongs to, use Medical Code Search API v3. Terminology Term Case Duration Definition A prediction for the length of disability of a case, based on a mathematical predictive model using ReedGroup s Population Database of disability claims. Case Fit v3 API Specification 1.3 Page 2 of 10

3 Term Case Frequency Comorbid Group Primary Diagnosis Code Definition An categorization for how frequently the Primary Diagnosis Code occurs within ReedGroups population database. Values are High, Medium, or Low. Diagnoses with a Low Case Frequency will not have a predicted Case Duration. See the Duration Views white paper for more details. A group of comorbidities defined by Quan et al (2005) (see Duration Views white paper), to simply the implementation of comorbidities. For more information see Comorbid Groups, below. The primary diagnosis for the patient s condition. The Case Duration supports the use of diagnosis codes in ICD-9-CM or ICD-10-CM. Two-digit procedural ICD-9-CM codes are not supported. Case Fit v3 API Specification 1.3 Page 3 of 10

4 2 API Specification This section documents the technical usage of the Case Fit API. General information about any of the MDGuidelines APIs can be found at MDGuidelines APIs are RESTful. Responses may be formatted as XML or JSON (see Section 2.4 Request Parameters, below). 2.1 Endpoint The Case Fit API endpoint is: Authentication The Organization s API license key must be provided via the request headers as RG-LICENSE-KEY. This key will be provided by the Customer s Account Executive at ReedGroup. 2.3 Version Information The current stable version of this API is v3. The currently supported version(s) of this API are: Version v3 Support End Date N/A* - Not announced *MDGuidelines will announce end of support at least 6 months in advance of the support end date. API product enhancements providing new response elements will require customers to upgrade in order to take advantage of the new capabilities. However, additional request parameters and/or enhanced algorithms or data in the response elements will not require an upgrade. Changes to data responses will be communicated at least 30 days in advance of publication. Case Fit v3 API Specification 1.3 Page 4 of 10

5 2.4 Request Parameters Data Element Data Req? Data Element Description Default Value Type medicalcode String Yes The medical code is provided as part of the end point URI. Case fit accepts ICD-9-CM or ICD-10-CM diagnosis values. N/A Example: /api/v3/durations/case/fit/ Response Data can be returned as JSON or XML. If using XML, the XSD may be found here: Data Element Data Req? Data Element Description Type ComorbidGroupRelevance Complex Yes A complex data element providing data for Comorbid Groups and their relevance to the Primary Diagnosis Code requested. Elements included: Code ToolName Description Examples Relevant code String Yes A short code for the Comorbid Group. Code values are need to request the Case Prediction using comorbidities. See Comorbid Groups for possible values. toolname String Yes Short description for the Comorbid Group. This value is displayed as the label in the Duration Views Case View tab in the MDGuidelines website. description String Yes A longer description for the Comorbid Group. examples String Yes A short list of examples of specific comorbid conditions which belong to the Comorbid Group. This can be used to guide user selection of Comorbid Groups. relevant Boolean Yes Indicator specifying whether the Comorbid Group has a significant effect on the predicted Case Duration for the Primary Diagnosis. Comorbid Group codes with relevant = false will have no effect on the overall predicted Case Duration. Values: true false Case Fit v3 API Specification 1.3 Page 5 of 10

6 2.6 Comorbid Groups Comorbid conditions have been grouped into categories to simply the implementation and use within the Case Durations tool. Tool Name Description Examples Code AIDS/HIV AIDS/HIV Human immunodeficiency virus [HIV] disease HIV Alcohol Abuse Alcohol abuse Alcohol Dependence; Alcohol-induced Alcohol persisting dementia; Alcohol induced sleep Arrhythmia Cardiac arrhythmias Atrioventricular block; Ventricular fibrillation and flutter; Atrial Fibrillation; Premature Beats Arrhythmia Blood Loss Anemia Blood loss anemia Iron deficiency anemia secondary to blood loss BloodLoss (chronic) CHF Congestive heart failure Rheumatic heart failure; Malignant CHF hypertensive heart disease with heart failure Coagulopathy Coagulopathy Coagulation defects; Primary thrombocytopenia Coagulopathy Deficiency Anemia Deficiency anemia Iron deficiency anemia secondary to inadequate dietary iron intake; Folatedeficiency anemia Anemia Depression Depression Major depressive disorder single episode; Depression Adjustment reaction DM Diabetes, uncomplicated Diabetes mellitus without mention of DM complication; Diabetes with ketoacidosis DM Complicated Diabetes, complicated Diabetes with renal manifestations; Diabetes DMcx with peripheral circulatory Drug Abuse Drug abuse Drug dependence; Drug-induced mental Drugs Fluid Disorder Fluid and electrolyte Disorders of fluid electrolyte and acid-base balance; Disorders of neurohypophysis (posterior pituitary) FluidsLytes GI Ulcer Heart Valve Disease HTN Complicated HTN Pulmonary Peptic ulcer disease excluding bleeding Chronic gastric ulcer without mention of hemorrhage or perforation; Chronic peptic ulcer of unspecified site without mention of hemorrhage or perforation Case Fit v3 API Specification 1.3 Page 6 of 10 PUD Cardiac valvular disease Rheumatic aortic stenosis; Mitral stenosis Valvular Hypertension, complicated Malignant hypertensive heart disease with heart failure; Malignant secondary hypertension Pulmonary circulation Chronic pulmonary embolism; Aneurysm of pulmonary artery Hypertension, Malignant essential hypertension; Benign uncomplicated essential hypertension HTNcx PHTN HTN HTN Uncomplicated Hypothyroid Hypothyroidism Congenital hypothyroidism; Iodine Hypothyroid hypothyroidism Liver Disease Liver disease Acute and subacute necrosis of liver; Chronic Liver hepatitis Lymphoma Lymphoma Lymphosarcoma and reticulosarcoma; Hodgkin Lymphoma disease; Non-Hodgkin Lymphoma Metastatic Cancer Metastatic cancer Secondary and unspecified malignant Mets neoplasm of lymph nodes; Secondary malignant neoplasm of ovary

7 Tool Name Description Examples Code Obesity Obesity Obesity; Overweight Obesity Other Neuro Other neurological Parkinson disease; Cerebral degeneration NeuroOther Paralysis Paralysis Flaccid hemiplegia; Quadriplegia and Paralysis quadraparesis Psychoses Psychoses Schizophrenic ; Delusional Psychoses Pulmonary Disease Chronic pulmonary disease Chronic pulmonary heart disease; Asthma; Pulmonary Chronic Obstructive Pulmonary Disease (COPD). PVD Peripheral vascular Atherosclerosis of aorta; Thoracic aneurysm PVD Renal Failure Renal failure Chronic kidney disease; Renal osteodystrophy Renal Rheumatologic Rheumatoid arthritis/ collagen vascular diseases Rheumatoid Arthritis; Polymyalgia rheumatica; Rheumatic Arthropathy in behcet syndrome Tumor Solid tumor without Malignant neoplasm of larynx; Malignant Tumor metastasis melanoma of skin Weight Loss Weight loss Protein-calorie malnutrition; Nutritional marasmus WeightLoss 2.7 Exception Conditions and Troubleshooting The service may provide response codes, for success or errors. The common response codes implemented in the MDGuidelines API are documented at Response Status Codes Status Code Cause(s) 400 Messages: Invalid parameter specified: [parameter name] The following parameter is required: [parameter name] Note: Currently there are no required parameters. 401 Message: License code not authorized. This response will be returned in the following scenarios: License key is expired License key is missing License key is otherwise invalid Case Fit v3 API Specification 1.3 Page 7 of 10

8 Status Code Cause(s) 404 Message: Supplied medical code not found: [medicalcode] This response will be returned in the following scenarios: Invalid medical code Medical code is of a non-supported type (e.g, CPT or ICD-10-PCS) 406 Message: Case prediction not available for [medicalcode] due to insufficient records or low return to work probability (<75%). This response will be returned in the following scenarios: The primary diagnosis Case Frequency is less than Medium (i.e., < 100 records). The primary diagnosis has a Medium or High Case Frequency, however the population statistic for probability that the case returns to full dute is less than 75%. In this case a prediction would be unreliable because of the significant number of cases not returning to full duty. 500 If the server, API site, or this service failed, the response will be a 500 Server error. Server outages are monitored by ReedGroup Information Technology. 2.8 Testing MDGuidelines offers two methods for integration testing: 1. User Acceptance Testing (UAT) Environment a. Notify Reed Group Account Management so that support resources can be made available for Customer testing. This will also ensure that the environment status is communicated to the Customer. b. The UAT environment requires UAT license key configuration (RG-LICENSE-KEY). c. Set the UAT endpoint to d. UAT website environment and base URL is e. The UAT environment is the only non-production environment available for Customer testing. f. The Customer may configure multiple test environments to point to UAT. 2. Test Harness Page a. b. Requires production license key configuration (RG-LICENSE-KEY) 3. API Testing tool, such as Postman a. Case Fit v3 API Specification 1.3 Page 8 of 10

9 2.9 Sample Code JQUERY var uri = " uri += "354.0"; $.ajax({ url: uri, type: 'GET', datatype: 'json', headers: { 'RG-LICENSE-KEY': 'XXXXXXXX-XXXX-XXXX-XXXX-XXXXXXXXXXXX', }, success: function (data) { handledata(data) }, error: function (xhr, status, error) { handleerror(xhr, status, error) } }) Case Fit v3 API Specification 1.3 Page 9 of 10

10 Document Revision History Date Reason For Changes Document Version 4/18/2017 Initial Version /22/2017 Fixed UAT end point URL /08/2017 Removed DRAFT status; no changes /23/2017 Updated link to help page. 1.3 Case Fit v3 API Specification 1.3 Page 10 of 10